Re-evaluating CT for dementia residents

If there's any category of residents that long-term care providers are paying attention to as they plan out the next decade, it's the dementia market. It's not a coincidence that many assisted living providers are expanding their dementia units. For better or worse, dementia can hit any family, including those with the financial resources to place their loved one in a high-end facility for the remainder of their years.

Yet for all of our interest in cognitive training for dementia patients, we also know that studies on the topic have varied in quality and reliability. In 2015, one researcher suggested in a McKnight's column that “in many cases, the success of specific brain fitness programs and initiatives themselves has not been formally evaluated.”

Now, a Finnish researcher, neuropsychologist Eeva-Liisa Kallio, has released an analysis with a warning. Her team reviewed 31 randomized controlled trials on cognitive training in dementia patients, and her results were published in the Journal of Alzheimer's Disease this month.

”The data regarding the effects of CT in patients with dementia is unclear,” the article states. “ … Despite some positive findings, the inaccurate definitions of CT, inadequate sample sizes, unclear randomization methods, incomplete datasets at follow-up and multiple testing may have inflated the results in many trials.”

Oof. In other words, it's possible many in long-term care have been hustled by those promoting their programs, even for those touting “research-based programs.”

To give the benefit of the doubt to many who talked up or believed in these programs, Kallio says many of the studies focused on cognitive functions immediately after the intervention. Plus, few studies included following up with patients looking at cognitive function not directly related to skills in the intervention.

Ultimately, Kallio's work doesn't mean providers should stop using cognitive training with dementia patients. But she also didn't find using them a necessity. That's a mixed bag for providers.

Here's why: Long-term care administrators are often pushed to consider programs that benefit dementia patients, and many believe it's hard to justify the cost. At the same time, these cognitive training programs give families (and to a certain extent, residents) the sense that the provider is doing something rather than letting their loved one fade away. Even for those families who recognize dementia is a progressive illness, it's emotionally helpful to think that cognitive training may give someone a “good” day.”

Additionally, I've seen how much residents can enjoy these types of activities. It's also important to remember that Kallio is looking at cognition, not emotional state. There's no reason to believe these programs can't still help with residents' anxiety or agitation, potentially allowing a reduction in antipsychotic usage.

But providers have to be realistic with both themselves and families about what is possible.

“Healthy adults can get limited benefits from cognitive training but we need more high quality trials to confirm cognitive training as an effective treatment option in dementia," Kallio says.

The University of Helsinki will next look at the effects of intensive, three-month cognitive training on the community-dwelling older individuals with dementia participating in adult day care activities organized by the City of Helsinki, according to a release on her work. Researchers will look at cognitive functions, quality of life and activities of daily living. Most critically, they'll take measurements six months after the intervention and include a 24-month health register follow-up.

For providers debating these types of programs for their facility in the meantime, my advice would be to contact researchers, find ongoing studies, or become part of pilots. It's short-sighted to give up cognitive training for dementia residents. But before anyone sacrifices their garden budget for another computer-based system, it's wise to consider what kind of return on investment to expect.